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Life sciences · Journal article
Ajpm Focus · September 10, 2026
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Underserved urban U.S. communities experience a disproportionate burden of uncontrolled hypertension, driven by structural and socioeconomic barriers. Community health workers may support sustained improvements in hypertension control and self-management. The authors systematically searched PubMed (2015-2025) for U.S.-based, urban, longitudinal community health worker-led interventions recruiting participants directly from community settings with reported pre/post blood pressure outcomes. Studies conducted in rural settings, recruiting from clinical settings, or lacking pre/post blood pressure data were excluded. Two investigators independently screened, extracted data, and assessed the risk of bias. Heterogeneity precluded meta-analysis; findings were synthesized narratively with attention to the evidence hierarchy. Ten studies met the inclusion criteria: 3 RCTs, 1 non-RCT, and 6 pre-post designs. Across the studies, community health worker-led programs commonly reduced blood pressure and improved self-management behaviors. Six studies (60%) reported significant reductions in blood pressure (systolic blood pressure: 2.3-20 mmHg; diastolic blood pressure: 1.6-7.4 mmHg). However, only 1 of the 3 RCTs demonstrated significant between-group differences in blood pressure; 2 showed no significant effect versus the controls. Interventions lasting at least 6 months consistently demonstrated significant improvements in blood pressure, whereas 3-month programs were less likely to show a significant change. Several studies reported improved medication adherence and increased self-monitoring of blood pressure at home. Longitudinal, community-based community health worker-led interventions are associated with improved hypertension control and self-management in underserved urban U.S. communities. Multicomponent, culturally tailored programs of at least 6 months that integrate medication support and linkage to care appear to be most effective. Future research should prioritize larger, rigorously designed RCTs, cost-effectiveness, and implementation strategies to enable the widespread implementation of effective community health worker models.